Systemic Tumor Seeding Secondary to Peritonitis due to the Immediate Postoperative Intravesical Instillation of Pirarubicin After Intravesical Explosion Induced Bladder Perforation During Bipolar Transurethral Resection of Bladder Tumors

Abstract

An 82-year-old man with multiple nonmuscle-invasive bladder cancer underwent transurethral resection (TUR) of bladder tumor by using the transurethral resection in saline (TURis) system. Intravesical explosion occurred during the resection of a tumor of the bladder dome, but no bladder perforation was detected. Immediate postoperative intravesical instillation of 30 mg pirarubicin in 30 mL saline was administered after the TURis. After this procedure, the patient complained of severe lower abdominal pain. A computed tomography (CT) scan after cystography revealed a collection of fluid in the abdominal cavity with signs of urine leakage. It was determined that instillation of pirarubicin led to leakage outside the bladder through a near perforation on the bladder that occurred during TURis. An indwelling 20 Fr Foley catheter was placed for 8 days. His condition improved without additional surgery. After the patient was discharged, gross hematuria appeared. A residual tumor was confirmed near the perforation area. Therefore, 3.5 months after the first TURis, he underwent a second TURis. Dyspnea appeared 1 month after the second TURis. Positron emission tomography and computed tomography (PET/CT) imaging revealed systemic tumor seeding. Five months after surgery, the patient died because of acute respiratory failure. J Med Cases. 2019;10(4):101-105 doi: https://doi.org/10.14740/jmc3277